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Cheung PKF, Chin RY, Eslick GD. Detecting Residual/Recurrent Head Neck Squamous Cell Carcinomas Using PET or PET/CT: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2015; 154:421-32. [PMID: 26715675 DOI: 10.1177/0194599815621742] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/19/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of positron emission tomography (PET) and PET/computed tomography (CT) for detecting residual and/or recurrent local and regional disease and distant metastases in patients with head and neck squamous cell carcinomas (HNSCCs) following radiotherapy with or without chemotherapy. DATA SOURCES A systematic review with no language restrictions was conducted using PREMEDLINE, MEDLINE, EMBASE, and Google Scholar. REVIEW METHODS Only prospective studies with histopathological and/or clinical follow-up that assessed the diagnostic accuracy of PET and PET/CT in detecting residual and/or recurrent disease following radiotherapy with or without chemotherapy in patients with HNSCCs were included. RESULTS Twenty-seven studies were identified. The pooled sensitivity and specificity of PET and PET/CT for detecting residual or recurrent disease at the primary site was 86.2% and 82.3%, respectively. For residual and recurrent neck disease, the sensitivity and specificity were 72.3% and 88.3%, while for distant metastases, the values were 84.6% and 94.9%. CONCLUSIONS PET and PET/CT are highly accurate in detecting residual and/or recurrent HNSCC. PET/CT is more specific than PET alone. Specificity is also greater for scans performed more than 12 weeks after radiotherapy with or without chemotherapy. The authors support the use of PET/CT after 12 weeks posttreatment for the assessment of residual or recurrent disease.
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Affiliation(s)
| | - Ronald Y Chin
- Department of Otolaryngology Head and Neck Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
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Present and future role of FDG-PET/CT imaging in the management of head and neck carcinoma. Jpn J Radiol 2015; 33:776-89. [DOI: 10.1007/s11604-015-0495-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 10/16/2015] [Indexed: 01/09/2023]
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Lauridsen JK, Rohde M, Thomassen A. 18F-Fluorodeoxyglucose–Positron Emission Tomography/Computed Tomography in Malignancies of the Thyroid and in Head and Neck Squamous Cell Carcinoma. PET Clin 2015; 10:75-88. [DOI: 10.1016/j.cpet.2014.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Choi HJ, Kang CM, Lee WJ, Song SY, Cho A, Yun M, Lee JD, Kim JH, Lee JH. Prognostic value of 18F-fluorodeoxyglucose positron emission tomography in patients with resectable pancreatic cancer. Yonsei Med J 2013; 54:1377-83. [PMID: 24142641 PMCID: PMC3809883 DOI: 10.3349/ymj.2013.54.6.1377] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE We evaluated the prognostic value of (18)F-2-fluoro-2-deoxyglucose positron emission tomography (FDG PET) in patients with resectable pancreatic cancer. MATERIALS AND METHODS We retrospectively reviewed the medical records of pancreatic cancer patients who underwent curative resection, which included 64 consecutive patients who had preoperative FDG PET scans. For statistical analysis, the maximal standardized uptake value (SUVmax) of primary pancreatic cancer was measured. Survival time was estimated by the Kaplan-Meier method, and Cox's proportional hazard model was used to determine whether SUVmax added new predictive information concerning survival together with known prognostic factors. p<0.05 indicated statistical significance. RESULTS Overall survival (OS) and disease- free survival (DFS) were respectively 42.9 months (27.6-58.2; 95% CI) and 14.9 months (10.1-19.7; 95% CI). When subjects were divided into two groups according to SUVmax with a cutoff value of 3.5, the high SUVmax group (n=32; SUVmax >3.5) showed significantly shorter OS and DFS than the low SUVmax group. Multivariate analysis of OS and DFS showed that both high SUVmax and poor tumor differentiation were independent poor prognostic factors. CONCLUSION Our study showed that degree of FDG uptake was an independent prognostic factor in pancreatic cancer patients who underwent curative resection.
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Affiliation(s)
- Hye Jin Choi
- Department of Nuclear Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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Zbären P, de Bree R, Takes RP, Rinaldo A, Ferlito A. Which is the most reliable diagnostic modality for detecting locally residual or recurrent laryngeal squamous cell carcinoma after (chemo)radiotherapy? Eur Arch Otorhinolaryngol 2013; 270:2787-91. [PMID: 23689805 DOI: 10.1007/s00405-013-2564-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 05/08/2013] [Indexed: 02/04/2023]
Affiliation(s)
- Peter Zbären
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital, Berne, Switzerland
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Rangaswamy B, Fardanesh MR, Genden EM, Park EE, Fatterpekar G, Patel Z, Kim J, Som PM, Kostakoglu L. Improvement in the detection of locoregional recurrence in head and neck malignancies: F-18 fluorodeoxyglucose-positron emission tomography/computed tomography compared to high-resolution contrast-enhanced computed tomography and endoscopic examination. Laryngoscope 2013; 123:2664-9. [DOI: 10.1002/lary.24077] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 12/15/2012] [Accepted: 02/05/2013] [Indexed: 12/18/2022]
Affiliation(s)
| | - M. Reza Fardanesh
- Department of Radiology; Mount Sinai Medical Center, New York; New York U.S.A
| | - Eric M. Genden
- Department of Otolaryngology/Head and Neck Surgery; Mount Sinai Medical Center, New York; New York U.S.A
| | - Eunice E. Park
- Department of Otolaryngology/Head and Neck Surgery; Mount Sinai Medical Center, New York; New York U.S.A
| | - Girish Fatterpekar
- Department of Radiology; Mount Sinai Medical Center, New York; New York U.S.A
| | - Zara Patel
- Department of Otolaryngology/Head and Neck Surgery; Mount Sinai Medical Center, New York; New York U.S.A
| | - Jongho Kim
- Department of Radiology; Mount Sinai Medical Center, New York; New York U.S.A
| | - Peter M. Som
- Department of Radiology; Mount Sinai Medical Center, New York; New York U.S.A
| | - Lale Kostakoglu
- Department of Radiology; Mount Sinai Medical Center, New York; New York U.S.A
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Agra IMG, Ferlito A, Takes RP, Silver CE, Olsen KD, Stoeckli SJ, Strojan P, Rodrigo JP, Gonçalves Filho J, Genden EM, Haigentz M, Khafif A, Weber RS, Zbären P, Suárez C, Hartl DM, Rinaldo A, Kim KH, Kowalski LP. Diagnosis and treatment of recurrent laryngeal cancer following initial nonsurgical therapy. Head Neck 2012; 34:727-35. [PMID: 21484925 DOI: 10.1002/hed.21739] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Surgery is the preferred modality for curative treatment of recurrent laryngeal cancer after failure of nonsurgical treatments. Patients with initial early-stage cancer experiencing recurrence following radiotherapy often have more advanced-stage tumors by the time the recurrence is recognized. About one third of such recurrent cancers are suitable for conservation surgery. Endoscopic resection with the CO(2) laser or open partial laryngectomy (partial vertical, supracricoid, or supraglottic laryngectomies) have been used. The outcomes of conservation surgery appear better than those after total laryngectomy, because of selection bias. Transoral laser surgery is currently used more frequently than open partial laryngectomy for treatment of early-stage recurrence, with outcomes equivalent to open surgery but with less associated morbidity. Laser surgery has also been employed for selective cases of advanced recurrent disease, but patient selection and expertise are required for application of this modality to rT3 tumors. In general, conservation laryngeal surgery is a safe and effective treatment for localized recurrences after radiotherapy for early-stage glottic cancer. Recurrent advanced-stage cancers should generally be treated by total laryngectomy.
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The role of PET/CT in the management of head and neck squamous cell carcinoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2011. [DOI: 10.1016/j.ejrnm.2011.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Abstract
Accurate diagnosis and staging are essential for the optimal management of cancer patients. Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) has emerged as a powerful imaging tool for the detection of various cancers. The combined acquisition of PET and CT has synergistic advantages over PET or CT alone and minimizes their individual limitations. It is a valuable tool for staging and restaging of some tumors and has an important role in the detection of recurrence in asymptomatic patients with rising tumor marker levels and patients with negative or equivocal findings on conventional imaging techniques. It also allows for monitoring response to therapy and permitting timely modification of therapeutic regimens. In about 27% of the patients, the course of management is changed. This review provides guidance for oncologists/radiotherapists and clinical and surgical specialists on the use of 18F-FDG PET/CT in oncology.
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Affiliation(s)
- Ahmad Almuhaideb
- Institute of Nuclear Medicine, University College London Hospitals National Health Service Trust, London, United Kingdom
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Ziober AF, D'Alessandro L, Ziober BL. Is gene expression profiling of head and neck cancers ready for the clinic? Biomark Med 2010; 4:571-80. [PMID: 20701444 DOI: 10.2217/bmm.10.71] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
One of the major challenges in the head and neck oncology clinic is the need to identify biomarkers and/or gene expression signatures that complement, strengthen and increase the sensitivity and specificity of the current clinicopathologic analyses. Microarray analysis of head and neck tumors has demonstrated that the combined influence of many genes or biomarkers can make superior identifiers and/or predictors of tumor behavior and patient outcome. Here, an update of the recent literature on the prognostic and predictive value of microarrays for patients with head and neck squamous cell carcinomas is presented. Microarray technology has the potential for improved decision-making and corroboration within the clinical setting. However, further integration, standardization, validation and research are required before the use of microarray analysis is ready for routine clinical management of head and neck squamous cell carcinomas.
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Affiliation(s)
- Amy F Ziober
- University of Pennsylvania Health System, Philadelphia, PA, USA
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Bellón Guardia ME, Pérez Romasanta L, García Vicente AM, Talavera Rubio MP, Palomar Muñoz A, González García B, Poblete García VM, Soriano Castrejón A. [Utility of PET-CT on radiotherapy planning of head and neck cancer. Our initial experience]. ACTA ACUST UNITED AC 2010; 29:157-64. [PMID: 20494489 DOI: 10.1016/j.remn.2010.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 03/09/2010] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To describe the methods used for the incorporation of FDG-PET-CT on radiotherapy planning of patients with head and neck cancer and also to evaluate the impact of FDG-PET-CT on staging and tumor volume definition. MATERIAL AND METHODS A prospective study in which 20 patients with head and neck tumor submitted for radiotherapy treatment were included. All underwent a whole body PET- CT (GE DSTE 16) for staging and restaging, also acquiring an additional 3h delayed PET image with diagnostic CT parameters for planning. A CT scan with diagnostic protocol, tabletop available for radiotherapy treatment and the same personalized head-shoulder mask were used in the latter. Lymph node involvement and/or distant involvement were evaluated, considering the changes in staging. We also evaluated the differences in volumes obtained between the different techniques. The threshold value used for delineating PET gross tumor volume (GTV) was empirically established and ranged from 20-40% of the maximum SUV. RESULTS Radiotherapy planning was performed with PET-CT in 20 patients between October 2007 to September 2008. A total of 29 lesions (18 primary lesions because 2 patients were excluded as no tumor was observed on the PET CT images, and 11 nodes). The most frequent location was oropharynx (5 patients). Mean maxSUV of the 29 lesions was 14.4 (range 5.0 and 26.4). No statistically significant differences were found between the GTV PET and GTV CT (mean 21.9cm³ and 19.3cm³, respectively). PET-CT modified the staging in 20% of the patients, with a diagnostic and therapeutic impact of 50 and 25%, respectively. CONCLUSION The incorporation of PET-CT in routine radiotherapy planning is a promising technique that requires close collaboration between the nuclear medicine and radiotherapy oncology departments. PET-CT achieves better staging in patients and has a significant diagnostic and therapeutic impact. The use of the hybrid technique avoids problems arising from co-registry as well as a second examination for planning with the consequent advantage for the patient. Nonetheless, more prospective and randomized studies with pathology specimens are needed to evaluate the real impact in the tumor volume definition.
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Affiliation(s)
- M E Bellón Guardia
- Servicio de Medicina Nuclear, Hospital General de Ciudad Real, Ciudad Real, España.
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Nagamachi S, Wakamatsu H, Kiyohara S, Fujita S, Futami S, Arita H, Tamura S, Kawai K. The reproducibility of deep-inspiration breath-hold 18F-FDG PET/CT technique in diagnosing various cancers affected by respiratory motion. Ann Nucl Med 2010; 24:171-8. [DOI: 10.1007/s12149-010-0352-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 12/09/2009] [Indexed: 10/19/2022]
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18F-FDG-PET/CT of orofacial tumors, a value of whole-body imaging approach. Eur J Radiol 2010; 73:241-8. [DOI: 10.1016/j.ejrad.2008.10.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 09/28/2008] [Accepted: 10/28/2008] [Indexed: 11/16/2022]
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Usefulness of a deep-inspiration breath-hold 18F-FDG PET/CT technique in diagnosing liver, bile duct, and pancreas tumors. Nucl Med Commun 2009; 30:326-32. [DOI: 10.1097/mnm.0b013e3283298f78] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Detection of locoregional recurrent head and neck cancer after (chemo)radiotherapy using modern imaging. Oral Oncol 2008; 45:386-93. [PMID: 19095487 DOI: 10.1016/j.oraloncology.2008.10.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
After radiotherapy with or without chemotherapy differentiation between residual and recurrent head and neck cancer and (chemo)radiation sequelae is often difficult. Currently, most physicians aggressively pursue potential recurrences, leading to a high rate of futile invasive diagnostic, e.g. examinations under general anaesthesia with taking of biopsies, and surgical procedures, e.g. planned neck dissections, and a waste of health care resources. Therefore, diagnostic techniques which reliably select patients who should undergo these procedures are warranted. Conventional imaging techniques are not reliable enough for this purpose. Potential imaging techniques to detect residual and recurrent locoregional disease after chemoradiation are (serial) CT or MRI and FDG-PET, eventually in combination with specific response criteria or scoring systems. Diffusion MRI and PET/CT may further improve these techniques. FDG-PET may help to select patients clinically suspected of recurrent laryngeal carcinoma after radiotherapy for direct laryngoscopy under general anaesthesia. It is not yet clear whether FDG-PET can reliable avoid futile routine evaluation by examination under general anaesthesia in oral and oropharyngeal cancer and planned neck dissection when a residual mass persists in the neck after (chemo)radiation. The most reliable scoring criteria and the optimal time interval between completion of radiation and FDG-PET still has to be assessed.
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Deantonio L, Beldì D, Gambaro G, Loi G, Brambilla M, Inglese E, Krengli M. FDG-PET/CT imaging for staging and radiotherapy treatment planning of head and neck carcinoma. Radiat Oncol 2008; 3:29. [PMID: 18801181 PMCID: PMC2559840 DOI: 10.1186/1748-717x-3-29] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 09/18/2008] [Indexed: 01/20/2023] Open
Abstract
Background Positron emission tomography (PET) has a potential improvement for staging and radiation treatment planning of various tumor sites. We analyzed the use of 18F-fluorodeoxyglucose (FDG)-PET/computed tomography (CT) images for staging and target volume delineation of patients with head and neck carcinoma candidates for radiotherapy. Methods Twenty-two patients candidates for primary radiotherapy, who did not receive any curative surgery, underwent both CT and PET/CT simulation. Gross Tumor Volume (GTV) was contoured on CT (CT-GTV), PET (PET-GTV), and PET/CT images (PET/CT-GTV). The resulting volumes were analyzed and compared. Results Based on PET/CT, changes in TNM categories and clinical stage occurred in 5/22 cases (22%). The difference between CT-GTV and PET-GTV was not statistically significant (p = 0.2) whereas the difference between the composite volume (PET/CT-GTV) and CT-GTV was statistically significant (p < 0.0001). Conclusion PET/CT fusion images could have a potential impact on both tumor staging and treatment planning.
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Affiliation(s)
- Letizia Deantonio
- Radiotherapy, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy.
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Prospective comparison of FDG and FET PET/CT in patients with head and neck squamous cell carcinoma. Mol Imaging Biol 2008; 10:364-73. [PMID: 18668293 DOI: 10.1007/s11307-008-0155-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 03/27/2008] [Accepted: 04/01/2008] [Indexed: 10/21/2022]
Abstract
AIM The clinical usefulness of 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET) in head and neck squamous cell carcinoma (HNSCC) is now well-documented. However, its sensitivity is greater than its specificity due to false-positive results in inflammatory or infectious lesions, which are frequent in this area, in particular after treatment by surgery and/or radiotherapy. O-2-fluoro-(18F)-ethyl-L-thyrosine (FET) has been reported not to be taken up by such lesions, and a preliminary study indicated that this may be clinically useful in HNSCC. We performed a prospective study to compare the diagnostic performances of FDG and FET PET/CT in the different settings of HNSCC. MATERIALS AND METHODS Twenty-seven patients (20 men and seven women, aged 48-76, among 30 patients included) and 69 suspected cancer sites are now evaluable on basis of postsurgical histology and/or follow-up greater than 6 months; 15 patients were referred for initial staging and 12 during posttherapy follow-up, a recurrence being suspected in eight of them. FDG and FET PET/CT were performed on two different days, the patient fasting for 6 h, 1 h after injection of 5 MBq/kg of body mass of each radiopharmaceutical. Both PET/CT examinations were blind read more than 6 months after the end of inclusions in a random order for each tracer and with a time interval greater than 1 month between FDG and FET PET/CT blind readings. RESULTS Overall diagnostic performances, derived from blind reading: FDG PET/CT on a per patient basis: sensitivity 100%, specificity 71%, accuracy 93%; FDG PET/CT on a per site basis: sensitivity 95%, specificity 63%, accuracy 83%; FET PET/CT on a per patient basis: sensitivity 70%, specificity 100%, accuracy 78%; FET PET/CT on a per site basis: sensitivity 64%, specificity 100%, accuracy 78%. At site level, sensitivity was significantly greater with FDG (p<0.02) and specificity with FET (p<0.01). The statistical level of significance was not reached at patient level. CONCLUSION Although its good specificity was confirmed, FET did not appear to be suited as a first-line PET tracer in HNSCC imaging and cannot replace FDG for staging due to insufficient sensitivity. However, it was useful in a few selected cases to favor a wait and see attitude when a FDG+ FET- focus was discovered in patients referred for systematic FDG PET during follow-up. In contrast, second primary cancers should not be ruled out if FDG was clearly positive in the lungs or the digestive tract.
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2008; 16:175-82. [DOI: 10.1097/moo.0b013e3282fd9415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE There are approximately 32,000 new cases of thyroid carcinoma annually in the United States. F-18 FDG PET/CT has an established role in cancer management, including thyroid cancer, usually in patients who are thyroglobulin (Tg) positive/iodine negative. We reviewed our experience with F-18 FDG PET/CT in thyroid cancer, with an emphasis on correlation with Tg, and maximum standardized uptake values (SUV). We also analyzed the role of thyroid stimulating hormone (TSH) on PET/CT results. MATERIALS AND METHODS This is a retrospective study (January 2003 to December 2006) of 76 patients with differentiated thyroid cancer, who had F-18 FDG PET/CT scans. There were 44 women and 32 men, with age range of 20 to 81 years (average, 51.1 +/- 18.1). The administered doses of F-18 FDG ranged from 396 to 717 MBq (15.8-19.4 mCi) (average, 566 +/- 74.8) (15.3 +/- 2). Reinterpretation of the imaging studies for accuracy and data analysis from medical records were performed. RESULTS A total of 98 PET/CT scans were analyzed (59 patients had 1 scan, 12 patients had 2, and 5 patients had 3). PET/CT was 88.6% sensitive (95% CI: 78.-94.3) and 89.3% specific (95% CI: 71.9-97.1). Mean Tg level was 1203 ng/mL (range, 0.5-28,357) in patients with positive PET/CT and 9.72 ng/mL (range, 0.5-123.0) in patients with negative PET/CT scans (P = 0.0389). Mean SUV max was 10.8 (range, 2.5-32) in the thyroid bed recurrence/residual disease and 7.53 (range, 2.5-26.2) in metastatic lesions (P = 0.0114). Mean SUV max in recurrent/residual disease in patients with TSH </=30 mIU/L was 9.3 (range, 2.5-34.1) and in patients with TSH >30 mIU/L was 8.1 (range, 2.6-32) (P = 0.2994). CONCLUSION F-18 FDG PET/CT had excellent sensitivity (88.6%) and specificity (89.3%) in this patient population. Metastatic lesions were reliably identified, but were less F-18 FDG avid than recurrence/residual disease in the thyroid bed. TSH levels at the time of PET/CT did not appear to impact the FDG uptake in the lesions or the ability to detect disease. In the setting of high or rising levels of Tg, our study confirms that it is indicated to include PET/CT in the management of patients with differentiated thyroid cancer.
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Affiliation(s)
- Andrei Iagaru
- Division of Nuclear Medicine, Stanford University School of Medicine, Stanford, California 94305, USA
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